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Labels and medications!
I have a history of recurrent depression for the last 20 years and a very strong family history of psychotic illness. Last year I after the longest stable stretch I was diagnosed with bipolar disorder. This was based on a period of 6 months where family and friends witnessed personality change caused by recklessness, elation and lack of sleep. I walked out of my job, finished a relationship of 11 years spent lots of money amongst other things. The psychiatrist told me that I had had at least 2 psychotic episodes and I am currently on a high dose of mood stabiliser and antipsychotic. However my CPN who visits weekly repeats the remark that she does not agree with the pdoc and that my 'mania' was only excitement and psychosis only anxiety. This is making me more and more irritated because I am on such a lot of medication and if it is not necessary I don't want to be taking them.
Such is my frustration that I have asked for an appointment with another psychiatrist to take a fresh look at my diagnosis. This could take months to come through. My question to you is - are there any other disorders where the primary symptoms are those of feeling speeded up, lack of sleep and severe paranoia ( for example I was certain that a client had poisoned me with LSD because I was hallucinating). I still struggle with paranoia actually and cannot watch the telly amongst other things but at least I can get by. I wonder if the seroquel 600mg has lost its effectivenes sometimes but then compared to life before perhaps I'm just greedy by wanting an even better better quality of life. Any comments would be appreciated.
Such is my frustration that I have asked for an appointment with another psychiatrist to take a fresh look at my diagnosis. This could take months to come through. My question to you is - are there any other disorders where the primary symptoms are those of feeling speeded up, lack of sleep and severe paranoia ( for example I was certain that a client had poisoned me with LSD because I was hallucinating). I still struggle with paranoia actually and cannot watch the telly amongst other things but at least I can get by. I wonder if the seroquel 600mg has lost its effectivenes sometimes but then compared to life before perhaps I'm just greedy by wanting an even better better quality of life. Any comments would be appreciated.
MEDICAL PROFESSIONAL
As you can imagine, diagnosing by internet is not a reliable activity, however I would agree with Jaquta that what happened sounds to me like bipolar.
One of the curious things about bipolar is that there is very little relationship between number and dose of medications needed to control symptoms and general level of functioning.
An example of this is that one of my highest functioning patients (a professional working full time, great relationship, with several leadership roles in the community) is on 2 antipsychotic medications and 2 mood stabilizers... and every time we try to reduce one of those medications she gets worse, so we are pretty sure she needs all four.
Another curious thing is that people with "side effects" from their medication are about as likely to be getting these side effects from the illness (which is not being adequately treated by the medicine) as from the medication itself. So that one perfectly sensible approach to someone concerned about feeling "drugged" by medications may be to add another medication, and thus treat the condition adequately, and relieve the "drugged" feeling which may actually be caused by depression.... I am not saying that that is always the answer, certainly sometimes people are overmedicated, I am just saying that depression itself feels to many people like being drugged.
WIth all of this complexity, it is extremely helpful to track your mood and your medications in some way to see the relationship between the two. We are working on getting better tools for bipolar on this site. There are also plenty of other options. I like the Finding Optimism tools (some cost). Also consider http://www.healthyplace.com/bipolar-disorder/diagnosis/bipolar-mood-chart/menu-id-67/. and http://bipolar.about.com/od/moodcharting/Mood_Charting.htm.
One of the curious things about bipolar is that there is very little relationship between number and dose of medications needed to control symptoms and general level of functioning.
An example of this is that one of my highest functioning patients (a professional working full time, great relationship, with several leadership roles in the community) is on 2 antipsychotic medications and 2 mood stabilizers... and every time we try to reduce one of those medications she gets worse, so we are pretty sure she needs all four.
Another curious thing is that people with "side effects" from their medication are about as likely to be getting these side effects from the illness (which is not being adequately treated by the medicine) as from the medication itself. So that one perfectly sensible approach to someone concerned about feeling "drugged" by medications may be to add another medication, and thus treat the condition adequately, and relieve the "drugged" feeling which may actually be caused by depression.... I am not saying that that is always the answer, certainly sometimes people are overmedicated, I am just saying that depression itself feels to many people like being drugged.
WIth all of this complexity, it is extremely helpful to track your mood and your medications in some way to see the relationship between the two. We are working on getting better tools for bipolar on this site. There are also plenty of other options. I like the Finding Optimism tools (some cost). Also consider http://www.healthyplace.com/bipolar-disorder/diagnosis/bipolar-mood-chart/menu-id-67/. and http://bipolar.about.com/od/moodcharting/Mood_Charting.htm.
I don't know a huge amount about meds but I would opt to take the lowest dose possible. Any medication changes need to be made in consultation with your psychiatrist though.
From what you write I see your psych nurse as being a destablizing part of your treatment team.
I personally, as a lay person, don't perceive your symptoms to be part of normal excitement or anxiety.
With severe paranoia I would say that an antipsychotic is appropriate (and needed).
If you have concerns you should raise them with your present psychiatrist. I would also look into the possibility of psychotherapy. (It always seems like a good idea for those with mental illness.)
It is always good to be receptive to all input. I would discuss your nurses alternative opinion with your doctor. She possibly sees you more frequently but your doctor will have more experience in diagnosing, etc. It's possible your family history may create some bias. The best thing is to discuss your concerns with your doctor and others in your treatment team and to make an informed decision based on all that info.
From what you write I see your psych nurse as being a destablizing part of your treatment team.
I personally, as a lay person, don't perceive your symptoms to be part of normal excitement or anxiety.
With severe paranoia I would say that an antipsychotic is appropriate (and needed).
If you have concerns you should raise them with your present psychiatrist. I would also look into the possibility of psychotherapy. (It always seems like a good idea for those with mental illness.)
It is always good to be receptive to all input. I would discuss your nurses alternative opinion with your doctor. She possibly sees you more frequently but your doctor will have more experience in diagnosing, etc. It's possible your family history may create some bias. The best thing is to discuss your concerns with your doctor and others in your treatment team and to make an informed decision based on all that info.
It is good that you have two psychiatrists agreeing on the same diagnosis, that is likely to be very reassuring.
I think there is a difference between labelling and misinformation. It sounds as though she may have been trying to protect you. Nobody should be made to feel ashamed of a diagnosis though.
Psychiatrists have more experience in prescribing psych meds. It's good that the meds have been addressed and sorted. Hopefully you will feel better for it.
You definitely sound much happier and confident about things. I agree, if you have reservations about anything, get another opinion.
Thank you for keeping us updated and for sharing your story with us.
I think there is a difference between labelling and misinformation. It sounds as though she may have been trying to protect you. Nobody should be made to feel ashamed of a diagnosis though.
Psychiatrists have more experience in prescribing psych meds. It's good that the meds have been addressed and sorted. Hopefully you will feel better for it.
You definitely sound much happier and confident about things. I agree, if you have reservations about anything, get another opinion.
Thank you for keeping us updated and for sharing your story with us.
Thanks Jaquta, I took your advice and went to see the other psychiatrist that I was on about who happens to be an expert in bipolar and asked for his opinion.
He stated that in his opinion that I have definately got bipolar and agrees with the other pdoc. He said that my cpn probably did not want to encourage labelling because she may have thought that it was a negative thing to get into.
Whilst I can understand that, I would still rather know, because there is a lot of medication involved and I need to feel justified in taking them. Another thing the psychiatrist said was that I was not only been given wrong advice from my GP about which meds to take and when, but that the two I am taking are not that compatible - the one cancels the effect of the other. This means that I have not been getting the full benefit of the antipsychotic which has left me vulnerable to breakthrough symptoms, and so has raised the dose to the level it needs to be.
The biggest thing I have learned - go and seek a second opinion when you are unsure about anything. You might learn things you never even thought about. :D
He stated that in his opinion that I have definately got bipolar and agrees with the other pdoc. He said that my cpn probably did not want to encourage labelling because she may have thought that it was a negative thing to get into.
Whilst I can understand that, I would still rather know, because there is a lot of medication involved and I need to feel justified in taking them. Another thing the psychiatrist said was that I was not only been given wrong advice from my GP about which meds to take and when, but that the two I am taking are not that compatible - the one cancels the effect of the other. This means that I have not been getting the full benefit of the antipsychotic which has left me vulnerable to breakthrough symptoms, and so has raised the dose to the level it needs to be.
The biggest thing I have learned - go and seek a second opinion when you are unsure about anything. You might learn things you never even thought about. :D
Thanks for asking the question. The doctor provided a lot of clear, useful information.
Just a thought, but have you ever been assessed for SAD -seasonal affective disorder?
An unknown for me would be whether therapy would help your mood/ help you manage your mood and thus require less medication that way. ?? Sometimes basic things such as eating and sleeping well and exercising and managing stress can help.
It's a very personal choice what you decide regarding mood and medication. It sounds like you still have a lot of questions. Would talking to your psychiatrist again be helpful, do you think? Any changes should always be made in consultation with your treatment team.
Good luck for everythig.
Just a thought, but have you ever been assessed for SAD -seasonal affective disorder?
An unknown for me would be whether therapy would help your mood/ help you manage your mood and thus require less medication that way. ?? Sometimes basic things such as eating and sleeping well and exercising and managing stress can help.
It's a very personal choice what you decide regarding mood and medication. It sounds like you still have a lot of questions. Would talking to your psychiatrist again be helpful, do you think? Any changes should always be made in consultation with your treatment team.
Good luck for everythig.
Thank you for your full and speedy response which I found very interesting. I have completed a mood tracker over the course of a year which shows a definite improvement in relation to medication which has allowed me to function at a reasonable level - I can hold a two day a week job (just) and live independently. I am lucky that I currently suffer minimal side effects. Every time the dose increased my mood symptoms decreased. However there is still a seasonal pattern in mood symptoms - curving down at winter and sharply up by end of March, but nothing compared to how bad it was before the AP's. Does this make any sense to you in the context of bipolar?
I have always had this pattern but have only sought help when the winter depressions became too much. Sometimes the symptoms spike within the curve just before a period - brief hallucinations that last a few seconds or an increase in paranoia. My dilemma - make do with OK, mild mood symptoms and the occasional distressing struggle in order to keep meds to a minimum, or add/increase a med and go for better / most of the time - if there is such an outcome! Thank you again for your insight and expertise.
Jaquta Thank you also for responding so swiftly. It is good to get the opinion of someone else that has has to deal with mental health professionals and I've taken on board all your remarks :-D
I have always had this pattern but have only sought help when the winter depressions became too much. Sometimes the symptoms spike within the curve just before a period - brief hallucinations that last a few seconds or an increase in paranoia. My dilemma - make do with OK, mild mood symptoms and the occasional distressing struggle in order to keep meds to a minimum, or add/increase a med and go for better / most of the time - if there is such an outcome! Thank you again for your insight and expertise.
Jaquta Thank you also for responding so swiftly. It is good to get the opinion of someone else that has has to deal with mental health professionals and I've taken on board all your remarks :-D
I hope the post doesn't give the impression that I'm just looking for a 'label'. I'm searching for an explanation so I can be fairly certain that the meds I'm taking are a) needed and b) the right ones. For example should I be on antianxiety meds instead of antipsychotic? Sorry to keep going on!
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